Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Thursday, August 30, 2012

For those of you in my neck of the woods, school starts
next week.For others, this may be your
first or second week of having to listen to your tweens complain about their
teachers, or how “Robby” broke their heart.Next week, my son starts pre-school and while he’s been in a home-based
daycare since he was 9 months old, next week he moves from 4 kids of varying
ages to a class of 16 3 – 4 year olds who if they are anything like my little
devil use the back of their hand or their sleeve to wipe their runny nose.

Most people are aware that daycares and schools are
breeding grounds for infections, particularly colds, flus and intestinal
illnesses.It’s inevitable that children
will “share” their germs in the daycare or school environment for the simple
factor of proximity.Close contact
besides helping to spread germs can also help to build up a child’s
immunity.There are of course, a few
simple precautions that can help keep kids (and yourself!) healthy as they head
back to school.

1.Teaching kids
to keep their hands clean is the number one way to avoid sick days.I now sound like my mother “Wash your hands
before we eat”, “Wash your hands after playing in the sandbox”, “Wash your
hands after you go to the bathroom!” Why do boys think because they can pee
standing up they do not need to wash their hands?

2.Teach kids the
importance of not to sharing hats, brushes, towels, washcloths, eye makeup or
eye drops with other people.What better
way for pink eye or lice to spread!

3.Keep their
area clean.Like cleaning their hands,
cleaning their desk top before eating can help reduce spread of intestinal
illness.I suppose germs could be a
source of protein for those picky eaters, but for their health and yours, its
best if avoided.

A study published in August 2011 in American Journal of Infection Control, reported that after students ages 5 to 15 received one
lesson in hand hygiene where they learned to sanitize their hands with alcohol
hand sanitizer three times during the school day, the number of kids who missed
four or more school days due to illness dropped by 66 percent. What’s more, the
researchers also reported a 20 percent rise in the number of kids with perfect
attendance, compared to the previous school year. Other studies show that
kids—and their parents--stay healthier if children wash their hands with soap
and warm water for 20 to 30 seconds (the length of time it takes to say the
alphabet or sing Happy Birthday) several times a day to scrub away germs.

Let’s consider the common cold. Kindergarteners average
12 colds a year, while older kids develop about seven.The cold season runs from September to March,
making these the highest risk months (no wonder we all look forward to
spring!). The virus that causes this upper respiratory tract can live for
several hours on contaminated objects, such as door handles, books, pens, or a
computer keyboard or mouse.How do we stop
the spread?Along with frequent hand
washing (especially before eating), taking a reusable water bottle to school
instead of using the water fountain can reduce kids’ risk for colds and other
infections since the parts of the fountain that students touch can become
contaminated with germs. If your kids catch a cold, teach them to sneeze or
cough into a tissue (or the inside of their elbow, if they don’t have a tissue)
instead of their hands, so they don’t spread the virus to everything they
touch.Finally, including disinfection
of all commonly touched surfaces such as desks, door handles, faucets, etc once
per day will go a long way to preventing transmission.

If you have kids heading back to school, I hope unlike me
you have your shopping done.If not, and
you happen to come across an Angry Birds Knapsack, give me a call!

Friday, August 24, 2012

When asked about Silver, the first thought is often with
regards to the precious shiny white metal that is used in making
jewelleries.Silver, in disinfection,
refers to colloidal nanoparticles of silver that are stabilized by chelating
molecules. This can range from solutions of silver nitrate in water to silver
dihydrogen citrate that is a more stabilized form in comparison. Silver
containing disinfectants have been used extensively for topical wound
applications and other medical surface antisepsis such as catheter surfaces and
gauzes for covering burns and wounds. In addition, silver has long been used in
water treatments as an additive. In terms of its application for general
surface disinfection, in the past decade the use of silver disinfecting agents
has increased dramatically.

From a cleaning perspective, almost none of the
generally-used silver containing solutions has cleaning abilities better than
pure water. For use as an environmental surface disinfectant, cleaning ability
needs to be taken into consideration both for removal of soils and bioburden
from surfaces to be disinfected, but also with respect to any effect that soils
may have on the disinfection capability of the product being used.

With respect to disinfection efficacy, silver containing
disinfectants are bactericidal, virucidal, and fungicidal and some formulations
have also been reported to show inactivation against Mycobacteria.Microbial resistance to silver containing
disinfectants have been reported in numerous studies along with detailed
descriptions of the mechanisms microbial resistance.

Oral administration of silver is generally considered to
induce minimal toxicity; however this can depend on the type of silver
containing compound and its concentrations. For example, extended uses of
silver containing agents on topical and nasal routes can cause Argyria, which
is a blue-grey darkening of the region’s skin.

Silver is considered as an environmental hazard because
of its toxicity, persistence and bioaccumulative potential. Ionic silver is
known to be one of the most toxic metal residues to aquatic organisms. An
example could be silver nitrate, which has high aquatic toxicity at even low
concentrations. Silver nanoparticles could enter the sewage plants and
seriously challenge the biological purification process during water treatment.
Soils and waters contaminated with silver ions are often viewed as low in
concentration when compared to other metal ions present; however silver is a
rare metal in nature and thus its perceived low concentrations are still higher
than its natural safe concentration in nature. Ultimately, silver’s toxicity to
living organism is limited by the exposure concentration and bioavailability.
The uptake level of silver ions, or silver containing compounds, by the
organisms’ cells is highly influenced by the form of silver.

Here’s how we would score silver-based disinfectants on
the key decision making criteria:

•Speed of
Disinfection – B to C

oContact times
range from minutes to hours depending on the type of silver-containing solution
used

•Spectrum of
Kill – B to C

oSilver
disinfectants can kill a selection of bacteria, virus, and fungi; however
performance in this criteria is tied to type of silver-containing solution

oSome
nanoparticle solutions have shown the ability to provide residual activity on
surfaces

•Cleaning
Effectiveness – D

oMost
formulations do not contain surfactants making their cleaning efficacy no
better than water

•Safety Profile
– C - D

oSilver is
generally considered to induce minimal toxicity; however this is dependent upon
the type of silver containing compound, its concentrations and bioavailability.

oIonic Silver
is one of the most toxic metal residues to aquatic organisms

•Environmental
Profile – D

oSilver is
considered as an environmental hazard because of its toxicity, persistence and
bioaccumulative potential

•Cost
Effectiveness – B to C

oCost is
dependent onthe formulation of the
disinfectant and thus the concentration at which silver ions are used.

Thursday, August 16, 2012

JEAPARDY QUESTION: “What does plaque on your teeth, the
slippery slime on river stones, the gel-like film on the inside of flower
vases, the unsightly stains in toilet bowls, the gunk that clogs your drains,
otitis media (ear infections) and bacterial endocarditis (infection of the
inner surface of the heart) have in common?”

ANSWER: “Nicole, what are BIOFILMS?”

In Lee’s “Are there Monsters in your drain” blog he
alluded to the issue of bacterial growth in the drains of sinks being the root
cause of outbreaks within healthcare facilities.The bacteria being “splashed” and contaminating
clean surfaces or items could be attributed to biofilm.

Biofilm as highlighted above is nothing new to the world
and can be found almost ANYWHERE!Literally translated, Biofilm means “life slime” and can basically
develop in any environment that has bugs (bacteria, fungi, yeasts, etc), has a
flow of water and has a surface on which to stick.When these bugs adhere to the surface they
excrete a slimy, glue-like substance that helps them stick to all kinds of
surfaces such as metals, plastics, rocks, implanted medical devices, teeth and
tissue.

Depending on where they are found and what organisms they
are comprised of, biofilms can be dangerous or beneficial.Biofilms are responsible for billions of
dollars in lost productivity due to equipment damage by causing pipes to plug
or corrode, however they can also be used to help treat environmental wastes
such as sewage or be used to manufacture medicines.As a society, we most commonly associate
biofilms with their related infections where biofilms can develop on medical
device surfaces such as catheters, medical implants or wound dressings.However, don’t be fooled, biofilms happily
colonize on many household surfaces such as toilets, sinks, countertops,
cutting boards and coffee pots!Poor
disinfection practices and ineffective cleaning products may increase the
incidence of illness associated with pathogenic organisms commonly found around
the home.

An outbreak in 1994 that caused hundreds of infections in
asthmatics pushed the concern of biofilms to the forefront.Pseudomonas aeruginosa, in its biofilm state
was able to survive the disinfection process during manufacturing of inhalers
and when used by unsuspecting asthmatics, was transported directly to the lung
tissue where it flourished.At least 100
people died from the biofilm infection.

Closer to my home, in 2000 an outbreak of E.coli O157:H7
killed 7 people and sickened some 2500 residents, many of them children.The drinking water system had been
contaminated by manure following heavy rains and the water treatment system did
not have appropriate levels of residual chlorine to kill the bacteria.During the “clean up” of the town’s
water-mains, flushing and swabbing of 41 kilometers of water-mains was
conducted and it was noted that increased levels of Coliform and other
bacterial populations were being isolated…..biofilm was being sloughed off the
sides of the water mains and continued to contaminate the water.Perhaps the next time your city undergoes
water-main cleaning and / or upgrades during the summer and invariably slows
down traffic you won’t grumble as much.What are a few extra minutes for your commute when the alternative could
lead to severe diarrhea or possible death?

Of course the most well known culprits for biofilm
generation are whirlpool tubs, hydrotherapy tubs orfoot spa baths.I can cite several well published outbreaks
associated with piping found in tubs.Biofilm can be shed from the pipes into the water and if you have sores
or breaks in the skin these may become infected as a result of this exposure.Perhaps now it makes sense why spas tell you
not to shave your legs before a pedicure or other treatment involving a
tub?If that’s not enough, the
circulation of water can aerosolize the bacteria making it easy to inhale and
as noted in the 1994 outbreak of asthmatics, inhaling biofilm bacteria directly
into your lungs is not a good thing!

So now that you’ll never be able to drink tap water, have
a pedicure or kiss your significant other in the morning for fear of coming in
contact with biofilm, let’s talk about how we deal with it.Oxidizing chemistries such as chlorine or
hydrogen peroxide have been recognized as being effective at both removing and
destroying biofilms.Good old fashioned
scrubbing (mechanical removal) can also help to remove most biofilms from
surfaces, however, to completely clean off and remove the biofilm slime
oxidizing chemicals will be needed.The
good news is that biofilms can be removed or destroyed by chemical and
mechanical means with consistent cleaning and disinfection practices. BUT – it
only takes a very short time for biofilm to re-establish itself and then you
have to start the battle all over again.As Lee suggested in his sink blog, having established procedures that detail
how to clean and disinfect and with what frequency to disinfect areas that are
harbingers of biofilm will help stop their growth and development.

I hope the next time you stay in a hotel you ask yourself
“When was the last time the lines of the in-room coffee maker were
cleaned?”You may reconsider making
yourself that pot of coffee……and people wonder why I’m a StarBucks girl……

Saturday, August 11, 2012

As far as I’m
concerned, if a book doesn’t make you say, “huh”, “ohh” or “mmh” at least a few
times during its reading, it was not time well spent (romance novels excluded
of course…those are just for mindless guilty reading pleasures!).But I do know one such book that was
peppered with such moments.If you
didn’t know that a group of dead flamingos in the Bronx Zoo heralded the North
American landfall of West
Nile Virus, or that an emergency dog-sled relay across Alaska to bring
diphtheria antitoxin to the stricken community of Nome was the birth of the
annual Ididarod race, then
you’ve not read Dr. Bonnie Henry’s book, “Soap,
Water and Common Sense”.

The title of the book
was unabashedly derived from a William Osler quote, “Soap and water and common
sense are the best disinfectants”.From
viruses to bacteria to parasites and fungi, Dr. Henry dispels some of the
all-too-common myths and misinformation about good bugs and bad bugs, and
offers an eye opening account of the history of disease as well as up-to-date
and accurate information on everything from the bugs we breathe to the bugs we
eat and drink to the bugs in our backyard and beyond.

Although much of the
wisdom on display in this book will not come as a surprise to professionals in
infection prevention and control, it is both an entertaining and educational
read.Her list of the “top 10 ways to
stay healthy” that predictably starts with hand hygiene, surprising ends with
“Use condoms”.That addition gave me
pause likely because it is not a preventative measure that is commonly
discussed in the manufacture of surface disinfectants (where I spend most of my
life) and is not much addressed elsewhere in the book.Nevertheless, it is an absolutely necessary
addition!In fact, there are little side
stories, quips and other surprises throughout the book that keep you moving
forward.

In her “Top 10 myths
and truths about bugs”, I found many ideas that all of us would be grateful to
see disseminated in the wider community.For example:

“Myth: My immune system is healthy, so I don’t
need immunization.Besides, vaccines are
dangerous.

Truth: Vaccines work with your immune system to
help you fight infection.A report of
potential link between MMR vaccine and autism has been debunked by scientific
evidence.Vaccines are safe and
effective, and our best protection against many infections.”

You only have to
follow the news about the increased cases of Whooping Cough (pertussis) in the
US to know that vaccines work!According
to the CDC, nearly 18,000 cases
have been reported so far in 2012 — more than twice the number seen at this
point last year with 9 pertussis-related deaths reported with the majority of
deaths occurring among infants younger than 3 months of age.

“Soap and Water &
Common Sense – The Definitive Guide to Viruses, Bacteria, Parasites and
Disease” is well worth the time to read and while the title may infer that the
book may be intended for those in healthcare related fields, the truth is the
book is intended for the larger community.In fact, it lends itself nicely for a book club discussion.For someone not immersed daily in the
prevention of infection, the “huh” moments will be plentiful indeed, and it may
even be a life altering (or at least health-improving) experience!

Wednesday, August 1, 2012

As a child I’m sure we’ve all had nightmares about the
monster under our bed, or perhaps hiding in the closet.However, I don’t personally believe I ever
feared the beast lurking in the sink drain.Unfortunately, this has become a very real concern or nightmare for
infection control professionals in healthcare facilities throughout North
America and likely around the globe. Multi-drug resistant strains of various
bacteria including Pseudomonas aeruginosa and Klebsiella oxytoca are taking up
residence in sink drains and wreaking havoc on the most immuno-compromised
patients. Just recently the infection control staff atMount SinaiHospital (MSH) in Toronto published a study recounting their strategy
for addressing an outbreak that was traced back to the prevalence of K. oxytoca
in the drains of their ICU handwashing sinks.This scenario echoes a similar situation encountered by staff at TorontoGeneral Hospital (TGH) years earlier.In the case of TGH, the bacterial strain was different but the source
was the same – the sink drain in the ICU handwashing sinks.Some of you may be asking – as I did when I
first came across the TGH study – how in the world does bacteria dwelling in
the deep, dark recesses of a sink drain infect dozens of patients in an
ICU?The simple answer: splashing.Fact is, a dark and damp sink drain is the
ideal location for bacteria to populate and proliferate.When the tap is running, any splashing that
may occur when the water hits the drain could spread germs to both neighbouring
hand contact surfaces and directly to the hands of healthcare workers whom are
trying to comply with their hand hygiene needs.So how can we solve this problem?

In both studies, two interventions played a major
role.The first addresses the degree of
splashing and is more complicated as it typically involves the renovation or
replacement of the sinks in favour of those that are engineered to minimalize
splashing.The second intervention seeks
to address the contamination at the source, so as to prevent the potential for
transmission to other surfaces even if there is some splashing.This involves the thorough cleaning and
disinfection of the sink drain on a regular basis.Unfortunately, because the sink drain is not
only a perfect breeding ground for bacteria but also the ideal environment for
the establishment of biofilm this tends to be a more involved task than
everyday cleaning and disinfection.In
these situations particularly close attention needs to be paid to ensuring that
the disinfectant remains wet on the surface for the required contact time.This can prove difficult in a sink drain
where a liquid disinfectant solution typically has fleeting contact with the
contaminated surface as it races down the drain.Therefore, preference should be given to
rapid acting disinfectants and those that may be available in gelled formats
which ensure adhesion to the surface and subsequent contact time
compliance.An equally important
consideration is the type of disinfectant chosen for the application.Preference should be given to oxidizing
chemistries (e.g. hydrogen peroxide, chlorine based solutions) as they will
chemically work to lift and remove the biofilm from the surface.Other chemistries such as quaternary ammonium
compounds are generally ineffective at penetrating and removing the biofilm.In addition to selecting the appropriate
disinfectant, the utilization of a tool to effectively clean the drains should
also be strongly considered.

So does your facility have a procedure in place to ensure
that your sink drains won’t be the cause of your next outbreak?